United States Preventive Services Task Force References in the ‘‘Patient Protection and Affordable Care Act’’, HR 3590


In several sections, the bill mandates that coverage, promotion and deductibles for preventive services, such as screening mammography, be based on grades determined by the USPSTF.  Factoring in the recent USPSTF recommendations to the proposed legislation, the following sections could affect coverage, as well as other aspects, of screening mammography services:

SEC. 2713 (a)(1) – Coverage of Preventive Health Services (pgs. 17-18)

  • Requires private insurers to cover preventive services that have a rating of “A” or “B” from the United States Preventive Services Task Force.  Under this provision, private insurers would not be required to provide coverage for breast cancer screening for women between the age of 40 and 49 since the USPSTF gave a grade of “C” for this age group.  Similarly, private insurers would not be required to provide annual screening for women between the age of 50 and 64 since the USPSTF only recommends screening every two years for this age group.  Women older than 74 may not be covered for screening at all as the USPSTF gives a grade of “I” for this age group.

SEC. 4004 (a)(2) – Education and Outreach Campaign Regarding Preventive Benefits (pg. 1150)

  • The Secretary of HHS shall provide for outreach and education campaigns raising the public’s awareness of preventive services recommended by the USPSTF.  Under this section the Secretary is required to disseminate screening information that includes recommendations by the USPSTF.  Therefore, the legislation would require the Secretary to promote only the latest USPSTF recommendations regarding screening mammography.

SEC. 4103 (b)(2)(E)(i) – Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan (pg. 1174)

  • This section provides a personalized prevention plan for Medicare beneficiaries.  Part of the personalized prevention plan includes a beneficiary screening schedule for the next five to ten years.  The screening schedule will be partly based on recommendations from the USPSTF.  Based on having to consult the USPSTF recommendations for planning a screening schedule, Medicare beneficiaries may not be advised to have an annual screening mammogram between the ages of 65 and 74 and may not be advised to have one at all after age 74.

SEC. 4105 (a)(n)(1)(A) – Evidenced-based Coverage of Preventive Services in Medicine (pgs. 1189-1190)

  • Under this provision, the Secretary of HHS can modify coverage of preventive services if it is consistent with the recommendation of the USPSTF.  In the case of the USPSTF recommendations for breast cancer screening, the Secretary would be in his/her right to adjust Medicare coverage for screening mammography to be consistent with the USPSTF’s latest guidelines.

SEC. 4106 (a)(13)(A) – Improving Access to Preventive Services for Eligible Adults in Medicaid (pgs. 1190-1192)    

  • This provision requires coverage of preventive services in Medicaid if those services receive a grade of “A” or “B” from the USPSTF.  Since the USPSTF grade for women receiving routine mammography between the ages of 40 to 49 is a “C”, Medicaid would not be required to cover screening mammograms for women in that age group.  In addition, Medicaid –eligible women between the ages of 50 and 64 would not be covered for annual screening mammograms as the USPSTF recommends screening mammograms every other year for this age group.